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Hair loss happens when new hair isn’t growing in to replace the old one. This is normal and usually occurs gradually with age. It can also happen in response to a medical condition, such as lupus (luh-KOO-sis) or telogen effluvium.
A number of things can cause temporary hair loss, including: hormonal changes during pregnancy, childbirth or menopause; scalp infections such as ringworm; and an immune system disorder called alopecia areata.
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A person may experience noticeable hair loss for a number of reasons. Sometimes, a dermatologist can diagnose the cause by doing a physical exam and asking questions about family and medical history. Other times, the doctor may need to run a blood test or scalp biopsy.
Hair follicles are sensitive to stress, which can trigger a hair-loss disorder called telogen effluvium. This condition causes hair to fall out from all over the head, rather than just from the part where the hair grows. Usually, this condition is caused by severe emotional or physical stress, such as having a baby, a major surgery or the death of a loved one. In some cases, the condition may also be caused by eating a diet low in protein or taking certain drugs or vitamins.
Another common cause of hair loss is a fungal infection of the scalp, which is called tinea capitis. This condition can cause circular patches of baldness that grow bigger over time. It is a common cause of patchy hair loss in children and can be treated with antifungal shampoo and oral medicine.
Hormonal imbalances can also cause hair loss. Specifically, conditions like hypothyroidism and hyperthyroidism can lead to thinning hair or bald spots. Some people may also notice that their hair becomes thinner and more brittle as a result of these hormone-related problems.
Other causes of hair loss include wearing tight ponytails or braids, which pull on the hair, and using hair products, such as dyes, gels, relaxers, and sprays. Additionally, a number of conditions can affect the structure of the hair shaft, including ectopic pregnancies and thyroid disease.
A doctor can detect some of these issues by examining the scalp and looking at the hair under a microscope. The doctor might also ask about a patient’s lifestyle and how the person takes care of their hair. The doctor can then determine whether the cause of the hair loss is a treatable condition, such as ringworm, hair loss from pregnancy or childbirth, or hormonal imbalances. Those treatments can reverse the hair loss and help the hair grow back normally.
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A doctor can zero in on the cause of hair loss based on your family history, health history and physical exam. They’ll also ask you about your diet, medications and hairdressing habits. They might recommend blood tests to look for conditions like low iron and thyroid problems. They might also take a small sample of skin from your scalp for laboratory testing.
If you have a medical condition, such as an autoimmune disease or cancer treatment, the doctor will prescribe medication to treat it. If your hair loss is caused by a fungus, they may recommend antifungal shampoo and oral medicine to kill the fungus. Other conditions that can cause temporary hair loss include extreme physical stress or shock, such as surgery or a severe illness, or a crash diet. Other causes are a thyroid disorder, sex-hormone imbalance and a serious nutritional deficiency of protein, iron, zinc or biotin.
Other signs and symptoms of hair loss include circular or patchy bald spots on the scalp, face or beard, loose strands in the shower or bathtub, an itchy, flaky scalp or clogged drains from too much hair falling out. Some people who suffer from a mental illness called trichotillomania have the urge to pluck hairs out of their head, eyebrows and other parts of the body, leading to patchy bald spots.
Some types of hair loss don’t need medical attention at all, such as the thinning and brittle hair that some women develop along their hairline (frontal fibrosing alopecia). Newborns’ hair usually falls out in the first few months of life and is replaced by permanent hair.
Other types of hair loss need immediate attention and often need medical treatment. These include alopecia areata (al-o-PEE-she-uh ar-e-A-tuh), which is an immune system disorder that causes patchy hair loss, hair thinning from pulling hair too hard (trichotillomania) and a fungal infection of the scalp called ringworm of the scalp.
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Hair restoration, or hair transplantation, can help a person with permanent hair loss. It involves moving healthy hair follicles from one part of your scalp to the area where you’re losing your hair. This procedure can make your hair look thicker and fuller. Two surgical methods are available: follicular unit transplantation (FUT) and direct hair implantation (DHI). Both have their pros and cons, but they can lead to a full head of hair for some people.
Medications can help treat certain kinds of hair loss. Generally, they need to be taken daily. Usually, your doctor prescribes topical minoxidil or oral finasteride. These medications can help slow the loss of your hair, but they’re not a cure for baldness. They don’t work for everyone, and they may stop working after a while. They’re best used in combination with other treatments, such as dietary supplements and other medications, or with surgery.
Hormonal changes and other medical conditions can also cause temporary or permanent hair loss. They include hormonal changes related to pregnancy, childbirth, menopause and thyroid problems, as well as the immune system disease alopecia areata and a fungal infection called tinea capitis, or scalp ringworm. In some cases, these conditions can be treated by using corticosteroid medications to suppress the body’s immune system and encourage new hair growth. The medication can be taken in pill form or as a topical solution or injection.
Some other treatments for permanent hair loss include a laser treatment called low-level light therapy (LLL), which has been shown to stimulate hair regrowth. Another treatment is platelet-rich plasma (PRP), which has been shown to be an effective treatment for some people with hair loss.
Other options for treating hair loss are wigs and hairpieces, which can be worn permanently or temporarily to cover up the condition. These are available in a variety of styles and colors. A doctor can also prescribe antifungal medicines to take by mouth or apply to the scalp. Radiation treatment for cancer or other illnesses, such as chemotherapy or radiation to the brain, can also cause hair loss in the irradiated areas.
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Hair loss symptoms include: a widening of the part, clumps of loose hair in your hairbrush or shower drain, and bald spots. Circular or patchy bald spots may be a sign of an infection (like folliculitis decalvans) or a condition that prevents hair from growing (like lichen planopilaris).
Treatment depends on what causes it. Some hair loss can be reversed. For example, hair loss due to pregnancy and hormone changes goes away when the levels go back to normal.
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Trichotillomania is an impulse control disorder in which a person compulsively pulls out their own hair. The behavior causes bald spots and damage to the scalp’s hair follicles. It affects 1-4% of the population and usually begins in early adolescence. It’s more common in females and may be triggered by stress, depression or anxiety. It can also cause other body focused repetitive behaviors (BFRBs), such as nail biting, skin picking and pulling out eyelashes and eyebrows. People with trichotillomania often fear their condition will be discovered, so they try to hide it by wearing hats or covering the head with Vaseline. They may also wear wigs or false eyelashes and eyebrows. In some cases, people with trichotillomania experience a range of other symptoms such as anxiety, low self-esteem and mood swings.
The main symptom of trichotillomania is unexplained and uneven-shaped patches of baldness on the scalp and other parts of the body. In addition, those who suffer from the disorder may have other symptoms such as blepharitis and infections of the hairline or face. They may also chew on or eat their own hair, which can lead to a serious medical condition called trichophagia, in which the ingested hair blocks the digestive tract.
Some experts believe that genetics and other mental health conditions are linked to trichotillomania. Others think that trauma, such as sexual abuse or loss of a loved one, can trigger it.
Treatment for trichotillomania is more successful when a psychiatric approach is combined with behavioral therapy. Psychiatrists can help patients understand the feelings that cause them to pull out their hair and work with them on strategies to overcome the urge. In addition, they can offer medication to reduce the severity of the symptoms. It is also helpful for those with trichotillomania to join support groups so they can share their experiences and find out that they are not alone. Treatment may also include habit reversal training, in which the patient keeps a log of their hair-pulling episodes and learns new behaviors to replace them. Hair replacement clinics can help people cope with the effects of trichotillomania by helping them find ways to manage their hair loss and promote regrowth.
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Scalp ringworm, or tinea capitis, is a fungal infection that affects the scalp and hair. It looks like a circular area of scaly, red, dry skin and is itchy. It can spread to other parts of the body, but it is usually confined to the head. It is similar to athlete’s foot (tinea pedis) and jock itch (tinea cruris). These infections are caused by fungi that thrive in warm, moist areas, such as between the toes and in skin folds. These infections are common in children, but they can occur at any age.
The most common symptom of scalp ringworm is itching. Sections of the scalp may break off, leaving scaly, red or bald-looking patches that slowly grow larger. Some people develop crusty, pus-filled blisters on the scalp called kerion. These can lead to permanent bald spots. In severe cases, the fungus invades the hairshafts, causing thinning of the hair and scalp.
Ringworm of the scalp is diagnosed by a visual exam. Medicated shampoo containing antifungal agents, such as ketoconazole or selenium sulfide, can prevent the infection from spreading. It is important to use this shampoo regularly. The doctor may prescribe a prescription oral antifungal medication as well.
Home remedies, such as apple cider vinegar or tea tree oil, have not been proven to be effective against ringworm of the scalp. These home treatments might irritate the skin or cause other side effects.
Prevention is the best way to avoid ringworm. Regular shampooing, frequent hand washing, and not sharing personal items are essential to keep fungi from spreading between family members. Children are especially susceptible to ringworm, so it’s important to teach them about hygiene and not sharing towels, combs, or other items. You can also disinfect combs and brushes by soaking them in a solution of equal parts water and bleach. It’s also a good idea to ask friends and family members not to share these items, either.
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Hair loss may occur as a side effect of a psychological disorder such as anorexia or bulimia. In addition to causing weight loss, these conditions can lead to vitamin deficiencies that cause hair to fall out because your body isn’t getting the nutrients it needs to grow healthy strands of hair. If this is the case, you’ll need to visit a mental health professional for treatment and to discuss alternative eating habits. Your doctor may also prescribe medications to help stop the hair loss.
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Stress can cause hair loss by triggering the production of excess hormones that affect the entire body. An imbalance of these hormones can trigger scalp problems such as dandruff and disrupt eating habits, leading to weight gain or loss. This kind of stress also raises androgen levels, which may trigger hair loss. This is why it is important to find ways to relax and de-stress, such as exercise, meditation, adequate sleep, healthy nutrition, avoiding alcohol and excessive caffeine, limiting nicotine use and not overindulging in illegal drugs or recreational substances.
Stress, as defined by Hans Selye, refers to any type of stimulus that causes a person to feel overwhelmed and out of control. This could include blaring lights, deafening noises or extreme heat or cold. Selye noted that people who felt they had little control over their lives were more susceptible to a wide range of health problems, including stomach ulcers, weight gain and hair loss.
If you are under severe emotional or physical stress, your hair follicles may enter a resting phase (telogen effluvium). This type of stress-related hair loss is often temporary and does not result in bald spots. A high fever, surgery, major illness, emotional crisis, crash diet or pregnancy are some of the most common triggers of this type of hair loss.
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Hair loss affects about one-third of women and can be emotionally distressing. But there are many treatments that can help.
Effective treatment starts with a thorough examination by a dermatologist. They will ask questions about how your hair and scalp have changed over time. They may test your blood for vitamin levels and hormones. They may also gently pull on your hair or examine it under a microscope for signs of damage.
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Hair loss can occur in a variety of ways, and it may be temporary or permanent. In many cases, a doctor can identify an underlying cause and treat it to restore healthy growth. For example, a fungal scalp infection called tinea capitis can lead to bald patches that may get larger over time. It’s usually accompanied by red or scaly patches and can lead to sores that ooze pus. Your doctor can prescribe antifungal medications to help treat the infection.
Hormonal imbalances can also cause hair loss, according to the Cleveland Clinic. An underactive thyroid (hypothyroidism) or overactive thyroid (hyperthyroidism) can disrupt the natural cycle of hair growth and rest, leading to sudden or gradual thinning or baldness. Autoimmune diseases that affect the thyroid can also cause this type of hair loss, such as Hashimoto’s disease and Graves disease.
Certain drugs can cause hair loss as a side effect, especially those that affect hormone levels, such as lithium, beta-blockers, warfarin, heparin and some chemotherapy medications. The most common drug-related hair loss is telogen effluvium, which causes the hair follicles to enter a resting phase too early. It typically appears within two to four months after starting the medication and can last up to six or eight months.
Other medications can also cause hair loss, such as sex hormones and some types of birth control pills. If you notice that you or your child are losing more than the normal 100 to 150 hairs per day, it’s important to see a doctor. Sudden or patchy hair loss is a sign of an underlying medical problem, and you should be evaluated by a physician to determine the best course of treatment.
Some types of hair loss can’t be reversed, such as a receding hairline called frontal fibrosing alopecia in women or pattern baldness that occurs in both men and women. However, you can take steps to protect your scalp from further damage by avoiding harsh hair treatments, wearing a hat or scarf while outside and using sun protection products when swimming or taking a hot shower.
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In most cases, dermatologists can determine the cause of hair loss through a physical exam and trichometric analysis. In addition, they will ask a number of questions, including when the loss began, its patterns and how much of your scalp hair is being lost. They may also ask if you have any family history of hair loss, as this can be a sign of an underlying health problem. In some cases, blood tests or other tests will be done.
Blood tests can tell doctors if you have a vitamin or mineral deficiency that’s contributing to your hair loss. For example, low levels of iron are common among menstruating women and those who eat a vegetarian diet, which doesn’t usually provide enough iron. They can also reveal thyroid disease, which is often the cause of thinning hair in both men and women.
If you’re losing hair due to a fungal infection, such as tinea capitis (scalp ringworm), your doctor will do a culture test by scraping or swabbing a small piece of scalp skin and sending it for lab testing. The test can take weeks to complete.
Other tests include the pull test, in which the doctor grasps about 40 strands of hair from different areas of the scalp and gently tugs them. If six or more strands come out, that’s a sign of active hair loss. A doctor can also perform a card test, which involves holding a felt card against the scalp and parting your hair to see if any strands break.
In some cases, the dermatologist will do a biopsy of the scalp to get more detailed information. This is rare for hair loss, but it may be needed if the diagnosis is unclear. It’s also sometimes used to test the effectiveness of a treatment. For example, if you’re getting platelet-rich plasma injections to stimulate hair growth, the results of the biopsy will help the doctor see if the treatment is working. If not, the doctor can switch to a different treatment. The doctor will also need to know how severe your hair loss is before making any changes to your medication.
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In cases of permanent hair loss, dermatologists can recommend treatment to slow the process and encourage regrowth. Treatment options include medications that inhibit the action of androgens (the sex hormones that cause hair loss in men), topical minoxidil (Rogaine) for men or women, and follicular activation treatments that stimulate growth by delivering nutrients directly to the scalp. Medications that treat thyroid disorders or scalp conditions like psoriasis and seborrheic dermatitis may help, as well as trichotillomania (impulse control disorder) or alopecia areata (when the immune system attacks healthy hair follicles). Hair transplant surgery is also an option for some patients.
Other possible treatments may include a low-stress diet, supplements that support hair growth, and avoidance of hairstyles that pull or tug at the hair. Dermatologists at NYU Langone can offer guidance about these and other ways to manage thinning hair and promote regrowth.
Antifungal drugs taken by mouth or applied topically can often clear up a fungal infection of the scalp called tinea capitis, or ringworm of the head. In rare cases, a dermatologist may inject corticosteroids into the scalp to reduce inflammation and encourage new growth.
For men with hereditary pattern baldness, finasteride (Propecia) or minoxidil (oral and topical Rogaine) can be used to stop the progression of thinning hair or even reverse it. These are the only FDA-approved medicines for this condition. They are available by prescription.
PRP therapy involves drawing blood, putting it in a centrifuge to separate out platelets and plasma, and then injecting the platelet-rich plasma into the scalp where hair loss has occurred. This is a relatively new procedure that shows promise for stimulating hair regrowth.
Other surgical procedures for treating baldness and promoting new growth are hair restoration, or transplantation; and scalp flaps. During these operations, hair-bearing skin from the back of the scalp is moved to slits in the areas where there is no growth. These are generally performed only for those with a limited area of baldness, and can be expensive. People with wide-spread baldness may not have enough donor sites from which to transplant, and may continue to lose hair.
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Hair loss can occur in a variety of ways. It may be in the form of circular or patchy bald spots. Some medications can also cause thinning or loosening of the hair.
Hereditary pattern baldness is the most common type of hair loss in men, usually starting with a receding front hairline. It can begin at any age, including the teen years.
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Hereditary baldness, also known as male pattern baldness or androgenetic alopecia, causes gradual hair loss in predictable patterns. It typically starts with thinning hair, then receding or balding of the temples and crown, and eventually leads to a full bald scalp. This type of baldness is common in men and can begin as early as the 20s, with many men experiencing significant hereditary baldness by their 30s. Hereditary baldness may be the only cause of hair loss in some patients, while others may experience it in conjunction with other factors such as hormonal imbalance, low-level stress, and nutritional deficiencies.
Genetics play a role in hereditary baldness, but it can be difficult to determine the precise genetics that lead to this condition. The good news is that baldness genes can sometimes skip generations, meaning that the genes of your parents’ fathers or grandfathers might not be responsible for your hereditary baldness. Additionally, there are ways to avoid baldness, such as using hair transplants, which remove healthy hair follicles from areas where you have less of them to replace those in more desirable areas.
Studies have shown that about 79 percent of male pattern baldness is hereditary, and that a mutation in the KITLG gene plays a major role. This is a protein that helps regulate hair growth, and if it does not function properly, it can trigger a pattern of baldness in men.
Researchers have also found that the X chromosome might be a factor in hereditary baldness. While this finding is still in its earliest stages, there are indications that the X chromosome is associated with a gene that affects androgen receptors, which can lead to baldness.
To test this hypothesis, the authors conducted a genome-wide association study on UK Biobank data for self-reported baldness and imputed X chromosome SNPs. They used a linear model of baldness pattern residuals, which were adjusted for age, assessment centre, genotyping batch and array, and 10 principal components to control for population stratification. The model predicts a polygenic score for baldness pattern, with scores being zero, 1, or 2 (the higher the score, the more severe the baldness). An area under the curve plot shows that the optimal autosomal and X chromosome polygenic score both achieve AUC values of 0.75 in distinguishing those with severe hereditary baldness from those without it.
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Hormonal changes caused by a thyroid disorder can cause hair loss, especially if the thyroid is underactive, according to MedlinePlus. Autoimmune diseases that affect the thyroid gland, such as Hashimoto’s thyroiditis and Grave’s disease, can also cause thinning of the hair and loss of hair. Other hormone-related conditions that may contribute to thinning hair are extreme physical or emotional stress, over-dosing on medications like blood pressure drugs and gout medicines, pregnancy, menopause and taking birth control pills.
Since hormones play a role in every major body process, when they get out of balance it can trigger an array of health symptoms. Those symptoms include hot flashes, bloating, infrequent or absent menstrual periods, increased breast size and milky discharge from the nipples (if you’re not breastfeeding). It’s important to consult with a doctor if you notice any of these issues. A sperm count for men and a pap smear for women can help determine if the imbalance is caused by a hormonal disease or something more serious. Treatment options will vary based on the cause of the problem.
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Hair loss can result from many types of injury to the scalp or hair follicles. This can include burns from hot combs, blow dryers and hair straighteners; fungal scalp infections such as tinea capitis (say: in-ee-a-poh-tis); chemical damage from dyes, perms and bleach; or trauma caused by pulling out your own hair — also known as trichotillomania (trik-oh-till-oh-MAN-ia).
This type of trauma usually results in scarring alopecia, which means that the damaged hair follicles do not grow back the same way they were before the injury. Scarring alopecia can affect any age group, but it is most common in children and teens. It is important to determine what causes traumatic hair loss and treat it early, because it can lead to permanent baldness.
Traumatic hair loss can also occur for reasons not related to injury, such as telogen effluvium caused by major illness or surgery and pregnancy. This type of hair loss occurs when the immune system triggers a temporary change in the normal pattern of hair growth so that fewer new hairs come in at the rate old ones fall out. It usually takes a few months for this type of hair loss to resolve.
Traction alopecia is one of the most common types of traumatic hair loss, especially among women of African descent. It is the result of prolonged or repetitive tension on the hair from a variety of styles, including braids, locks and hair wraps. Early traction alopecia doesn’t cause scarring, but long-term traction can lead to permanent bald patches.
The condition is characterized by a circular pattern of thinning, with the edges of the bald patch overlapping with the edges of the remaining hairs. This is most often seen in women who wear their hair in tight braids, locks and other styles that put strain on the scalp. Hairs at the site of traction alopecia are brittle and easily broken. On microscopy, they have a nodule appearance, with the distal ends of the hairs resembling two broomsticks stuck together.
Traumatic alopecia due to injury or chemical abuse can usually be reversed once the source of the problem is eliminated. For example, hairs may regrow after removing a wig or allowing the scalp to cool down after using heat-producing styling tools. In addition, limiting exposure to chemicals and stress and incorporating regular scalp massages into your hair care routine can also help prevent traumatic alopecia.
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A disease can cause a sudden loss of hair. Sometimes the hair loss is a sign of an illness, such as systemic lupus erythematosus (lupus) or syphilis, and can lead to other symptoms, such as kidney problems, joint pain, anemia or depression. In other cases, the disease can cause a change in the way the body makes or uses certain hormones. For example, some medicines used to treat high blood pressure, heart problems or gout can cause hair loss. The disease can also cause changes in the normal cycle of hair growth and rest, causing thinning or patchy hair loss.
Severe physical or emotional stress can shock the body’s hair follicles, causing them to go into the resting (telogen) phase too early. This type of hair loss is called telogen effluvium, and usually goes away within six to eight months.
Other diseases that can affect the scalp or hair follicles include fungal infections, such as tinea capitis; hair pulling disorders, such as trichotillomania and traction alopecia; and medical treatments such as radiation therapy to the head and chemotherapy for cancer. A doctor will diagnose these conditions based on a careful history, examination and tests. These may include a hair sample that is sent to the laboratory for testing; blood tests, such as for thyroid problem and iron deficiency; or an image of the scalp that shows the size of the hair follicles and whether they are growing normally.
Some types of hair loss do not need treatment. For example, newborn hair is lost in the first few months of life, and it does not grow back. Other hair loss that does not need treatment is alopecia areata, which happens when the immune system mistakenly attacks hair follicles and causes them to die and fall out in patches on the scalp or elsewhere on the body. This condition can be treated with steroids that help hair follicles grow back, or with other medications to control an overactive immune system. Other conditions that do need treatment include ringworm of the scalp, which is caused by a fungus and can be treated with an antifungal medicine that you put on your skin or take as a pill.